The rational use of i.v. hydrochloric acid in the treatment of metabolic alkalosis.

A method for the assessment and management of factors both causing and maintaining a primary metabolic alkalosis is presented. During a 2-year period 65 patients with metabolic alkalosis were treated with saline and potassium chloride infusions. In four patients the alkalosis was refractory and required additional therapy. An infusion of hydrochloric acid 0.12-0.24 mol/litre through a central venous line corrected the alkalosis without causing haemolysis or tissue necrosis. The maximum rate of infusion suggested is 0.2 mmol H+-kg body wt-1-h-1.